Journal of Shanghai Jiao Tong University (Medical Science) >

2022 , Vol. 42 >Issue 4: 415 - 421

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.04.003

High-risk pregnancy column

Analysis of risk factors for postpartum thrombotic disease

  • Yueyue ZHU ,
  • Jinwen ZHANG ,
  • Ruixiang MA ,
  • Cailian CHEN ,
  • Yi LIN ,
  • Xiaorui LIU
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  • 1.Central Laboratory of The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Embryo Original Diseases; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
    2.Department of Automation, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University; Key Laboratory of System Control and Information Processing, Ministry of Education, Shanghai 200240, China

Received date: 2021-11-29

  Accepted date: 2022-04-11

  Online published: 2022-04-28

Supported by

National Key R&D Program of China(2018YFC1002800);National Natural Science Foundation of China(82171669);Shanghai Jiao Tong University Trans-Med Awards Research (Major Project)(20210201)

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Abstract

Objective

·To explore the high-risk factors and provide guidance for the prevention of postnatal thromboembolism.

Methods

·Based on a retrospective case-control design, a total of 45 262 electronic cases of women giving birth in the International Peace Maternal & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from 2018 to 2020 were excavated. The case group was 60 parturients diagnosed with postpartum venous thrombosis or pulmonary embolism, while the control group was 45 202 parturients who were normal. Multivariate logistic regression analysis was used to find the risk factors of postpartum thrombosis.

Results

·The incidence of postpartum venous thrombosis was 130/100 000 and pulmonary embolism was 46/100 000. The incidence of postpartum thrombotic disease showed a trend of increasing year by year (P<0.05). The left lower extremity was the main site of postpartum thrombosis. In this study, the average age of the mothers at delivery was 33.52±4.79 years old in the case group and 31.35±4.01 years old in the control group. The proportion of preterm birth in the case group was 2.05 times that of the control group, and the proportion of pre-pregnancy overweight and obese was 1.94 times that of the control group. Multivariate Logistic regression analysis showed that the elder age (aOR=1.10, 95%CI 1.04?1.17), the smaller the gestational age (aOR=0.88, 95%CI 0.78?0.99), less than a bachelor's degree (aOR=2.24, 95%CI 1.20?4.18), elective caesarean (aOR=6.68, 95% CI 2.56?17.41), emergency caesarean (aOR=14.40, 95%CI 5.37?38.63) and pre-pregnancy overweight and obesity (aOR=1.91, 95%CI 1.04?3.49) all increased the risk of postpartum thrombosis.

Conclusion

·Maternal age, education level, gestational age, overweight and cesarean section were independent risk factors for postpartum thrombosis. The most prominent risk factor was emergency cesarean section. The occurrence of postpartum venous thrombosis was associated with a variety of risk factors and can lead to maternal death. Clinicians need to assess the risk of thrombosis in time, and take preventive measures as soon as possible for women with high risk factors to reduce the risk of postpartum thrombosis.

Key words： postpartum thrombotic disease; risk factors; emergency cesarean section

Cite this article

Yueyue ZHU , Jinwen ZHANG , Ruixiang MA , Cailian CHEN , Yi LIN , Xiaorui LIU . Analysis of risk factors for postpartum thrombotic disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022 , 42(4) : 415 -421 . DOI: 10.3969/j.issn.1674-8115.2022.04.003

References

1 YU D, ZHANG L, YANG S, et al. Trends, causes and solutions of maternal mortality in Jinan, China: the epidemiology of the MMR in 1991-2020[J]. BMC Public Health, 2021, 21(1):1792.
2 COHEN S L, FEIZULLAYEVA C, MCCANDLISH J A, et al. Comparison of international societal guidelines for the diagnosis of suspected pulmonary embolism during pregnancy[J]. Lancet Haematol, 2020, 7(3):e247-e258.
3 HEIT J A, KOBBERVIG C E, JAMES A H, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study[J]. Ann Intern Med, 2005, 143(10):697-706.
4 KAMEL H, NAVI B B, SRIRAM N, et al. Risk of a thrombotic event after the 6-week postpartum period[J]. N Engl J Med, 2014, 370(14):1307-1315.
5 王子莲, 耿慧珍, 赵先兰, 等. 中国九家医院孕产妇静脉血栓栓塞症的发病现状及危险因素调查[J]. 中华妇产科杂志, 2020, 55(10): 667-672.
5 WANG Z L, GENG H Z, ZHAO X L, et al. Survey of related factors of maternal venous thromboembolism in nine hospitals of China[J]. Chin J Obstet Gynecol, 2020, 55(10):667-672.
6 中华医学会妇产科学分会产科学组. 妊娠期及产褥期静脉血栓栓塞症预防和诊治专家共识[J]. 中华妇产科杂志, 2021, 56(4): 236-243.
6 Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association. Expert consensus on the prevention, diagnosis and treatment of venous thromboembolism during pregnancy and puerperium [J]. Chin J Obstet Gynecol, 2021,56(4):236-243.
7 ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS. Reducing the risk of venous thromboembolism during pregnancy and the puerperium pregnancy and the puerperium (Green-top Guideline No. 37a)[EB/OL]. London: Royal College of Obstetricians and Gynaecologists, 2015[2021-11-20]. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf.
8 SULTAN A A, TATA L J, WEST J, et al. Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom[J]. Blood, 2013, 121(19):3953-3961.
9 JAMES A H. Venous thromboembolism in pregnancy[J]. Arterioscler Thromb Vasc Biol, 2009, 29(3):326-331.
10 姚杰, 杨涛, 郝斌, 等. 妊娠和产褥期静脉血栓栓塞的临床特征及治疗[J]. 中华围产医学杂志, 2020, 23(3): 203-207.
10 YAO J, YANG T, HAO B, et al. Clinical characteristics and treatment of maternal venous thromboembolism [J]. Chin J Perinat Med, 2020, 23(3): 203-207.
11 SOBREIRA M L, MAFFEI F H, YOSHIDA W B, et al. Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases[J]. Int Angiol, 2009, 28(5):400-408.
12 KIM S H, PATEL N, THAPAR K, et al. Isolated proximal greater saphenous vein thrombosis and the risk of propagation to deep vein thrombosis and pulmonary embolism[J]. Vasc Health Risk Manag, 2018, 14:129-135.
13 SHAN D, QIU P Y, WU Y X, et al. Pregnancy outcomes in women of advanced maternal age: a retrospective cohort study from China[J]. Sci Rep, 2018, 8(1):12239.
14 JACOBSEN A F, SKJELDESTAD F E, SANDSET P M. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study[J]. J Thromb Haemost, 2008, 6(6):905-912.
15 GUAN P, TANG F, SUN G, et al. Prediction of emergency cesarean section by measurable maternal and fetal characteristics[J]. J Investig Med, 2020, 68(3):799-806.
16 上海市母婴安全专家委员会, 上海市医学会围产医学专科分会, 上海市医学会妇产科专科分会产科学组, 等. 上海市产科静脉血栓栓塞症的综合管理共识[J]. 上海医学, 2020, 43(12): 709-714.
16 SHANGHAI MATERNAL AND INFANT SAFETY EXPERT COMMITTEE, SHANGHAI MEDICAL ASSOCIATION PERINATAL MEDICINE BRANCH, SHANGHAI MEDICAL ASSOCIATION OBSTETRICS AND GYNECOLOGY BRANCH OBSTETRICS GROUP, et al. Consensus on comprehensive management of venous thromboembolism in obstetrics in Shanghai[J]. Shanghai Med J, 2020,43(12):709-714.
17 徐园, 杨旭, 邓海波, 等. 下肢DVT患者疾病认知水平及影响因素分析[J]. 中华现代护理杂志, 2020, 26(2): 173-177.
17 XU Y, YANG X, DENG H B, et al. Disease cognition and its influencing factors in patients with lower extremity DVT [J]. Chin J Mod Nurs, 2020, 26(2):173-177.
18 BLONDON M, HARRINGTON L B, BOEHLEN F, et al. Pre-pregnancy BMI, delivery BMI, gestational weight gain and the risk of postpartum venous thrombosis[J]. Thromb Res, 2016, 145:151-156.
19 ABDUL S A, GRAINGE M J, WEST J, et al. Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England[J]. Blood, 2014, 124(18):2872-2880.
20 KHAN F, VAILLANCOURT C, BOURJEILY G. Diagnosis and management of deep vein thrombosis in pregnancy[J]. BMJ, 2017, 357:j2344.
21 CREANGA A A, SYVERSON C, SEED K, et al. Pregnancy-related mortality in the United States, 2011-2013[J]. Obstet Gynecol, 2017, 130(2):366-373.
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